May-thurner syndrome - Diagnostic and therapeutic dilemmas (RCD code: I-1D.2)

Abstract

May-Thurner Syndrome is a rare vascular disease in which the right common iliac artery compresses the left common iliac vein. It oc- curs 5 times more often in women than in men, usually in their 20s and 40s. Patients suffer from deep vein thrombosis, post-thrombotic syndrome, and pulmonary embolism. They usually present with swelling of the left leg, chronic leg pain, skin colour changes, tingling and/or numbness of the affected limb, varicosities, phlebitis, and venous stasis ulcers. Available diagnostic tests include venous duplex ultrasound, computed tomography, magnetic resonance imaging, venography, and intravascular ultrasound. Endovascular therapy, in- cluding angioplasty, stenting, and catheter-directed thrombolysis is the current mainstay of treatment. Long-term anticoagulation and elastic compression stockings are used to prevent recurrent blood clot formation and decrease the risk of post-thrombotic syndrome. Thrombophilia screening is essential, as it would aid in the decision-making process regarding continuation of anticoagulant therapy. We present the case of a 38-year-old woman in her fourth pregnancy, presenting with persistent left leg oedema and recurrent deep vein thrombosis, eventually diagnosed with May-Thurner Syndrome.